Provider Demographics
NPI:1679170062
Name:TOTAL HORMONE REPLACEMENT
Entity Type:Organization
Organization Name:TOTAL HORMONE REPLACEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARBUCKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-705-2761
Mailing Address - Street 1:2859 VIRGINIA BEACH BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7622
Mailing Address - Country:US
Mailing Address - Phone:757-644-4615
Mailing Address - Fax:757-578-2282
Practice Address - Street 1:2859 VIRGINIA BEACH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7622
Practice Address - Country:US
Practice Address - Phone:757-644-4615
Practice Address - Fax:757-578-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center